hi everyone and welcome to the viva boot camp online videos my name is lahiru i'm a full-time
anesthetist at western health in victoria and with these online videos i want you to just go
through them at your own pace and stop at the appropriate moment so you can practice your
answers so make sure you speak out your answers i want you to get really used to thinking on the fly
talking out your answers as you would normally in a viva to get the best
experience out of these videos and so now i'll transition to the actual videos from today
so i do a lot of teaching um in various ways but i think what i really enjoy is trying to
find a niche that isn't formally taught that isn't formally you know dressed by anse or any
of the colleges and just trying to fill that gap um of teaching and try to try to i guess
deliver something that's worthwhile with wilds with trainees this fiber bootcamp started when
i first became a consultant back in 2014 and what i noticed that a a lot of the things that
we came up in our study group by just watching the best people and people are really amazing
at talking in in tricky situations in the viva as well as modeling ourselves off the past exam prize
winners and the consultants we thought were just so good at communicating we used those techniques
and i i thought those those specific techniques and language structures were just a massive reason
why i did so well in the exam um back in 2012 so i thought you know i've been running this for
quite a few years now and pretty much just giving this at the right time um for you guys to i guess
digest it after you've gone through a lot of your knowledge and your and your study as it
is um the best part about this stuff i really love teaching this it's it's really harnessing
what you already know but just to take that knowledge and try to make it and synthesize it to
make your answers sound sharper clearer and with more impact and the more i've thought about this
in in my actual day-to-day practice it really doesn't feel like it's just exam technique
it really feels like this is what it takes for me to communicate better and more efficiently
with my staff as well as organize my thoughts a lot better as well so obviously there's an
online format and anyone who's done my lectures for the you know for the part two course or my
other other sessions they know that i try to make it as interactive as possible so i'll go through
lots of different cases and i'll really try to drill those points i'm trying to get across
and what will happen everyone's on mute right now so they can speak through the phone or in person
to their partner going through these exercises just taking in turn one case per person because
again i feel like this exam is all about trying to replicate the situation that you'll be in
you'll be in this in this environment where you're speaking to a colleague about a complex
scenario and that can be quite confronting so if you're not speaking if you're not in
that position where you're putting your thoughts out there for judgment that's something that you
really need to get used to to get through this exam um and there'll be you know little point in
your preparation as you've seen of not trying to play the game as it's played in in real life after
that i'll then just you know request someone on the screen to share their answer um after i hear
that answer i'll just share my approach and make any suggestions but the most important thing to
know is that you know this is just your opinion in my opinion and you know a lot of the time based on
what someone says i will change my answer for the next time because they may have raised a really
good point that i haven't thought about either i want to stress you to a certain extent as well
just to you know enhance that learning experience so i expect that everyone will be tied by the end
of the day and that's exactly what we want i make this general disclaimer which is pretty
obvious that you know this is not medical advice any specific patient you've had you really need to
do do the management based on your treating team and the consultant now this is one of the biggest
things that we we do in our sim training which is that you know we come from a place that i
you know i believe that everyone participating in this session today is intelligent and capable and
you know cares about doing their best and wants to improve so you know you might say a really
amazing answer at one time and another person might say an answer that they you know wish they
could change and that's completely fine there's about just doing your best trying to improve
getting all your mistakes out now because trust me you'll be making plenty of errors
and mistakes over the rest of your career but this is about improving and the only way you can
improve is constant small failures and that's completely fine as well now i wanted to just
just make make note of something that i think we all go through um this exam for me was actually
the hardest you know mental strain for me in my in my whole life really and that's that's
i guess that's kind of a privilege that an exam is the hardest mental strain i've gone through
um but again it's still real and i know a lot of you will be having it having a bit of a hard time
plus add-on covert 19 with that it's it's really it's really a you know tricky situation so
you know there's nothing wrong with seeking help i know there's a lot of resources out there these
days but really important that that's a that's a thing seeking help just talking to someone
whether it's a gp or a friend and taking time off if you need it um because you know
nothing is going to be as important as your health because this career you've got is it's it's in the
decades not in the you know not not in the weeks to months but i also try to fall back on this um
which didn't help me at the time but you know it's something i think of a lot these days um that you
know even if i fail at everything in life from here i'm still one of the most successful people
that have lived on earth and that's really ever in the history of time so i try to think of that just
philosophically because i know that this this process especially for you guys is going to be
very tricky and very difficult just to go through you know why is this exam challenging i've thought
a lot about this over the past um and i think it's the fact that it's a very odd training process we
have a grueling first part exam which isn't very clinically based and we spend a lot of time uh you
know spent on that maybe up to 12 to 24 months on that then we relax after losing we're losing our
life to the exam and over the next few years with so many different consultant supervisors ian each
of these supervisors will tell you that their way is the best way and that other way that the
consultant the other consultant did just yesterday you know is ridiculous um so with those different
opinions the different hospitals different approaches and opinions anything that suddenly
becomes a bit more complex and conflicting with multiple issues can be challenging and i think
this exam is a lot about finding what that what that normal is so i think this exam is necessarily
difficult because of the process you've been through with making with the lack of decision
making and the the delay in decision time that you've had so i think it's really interesting that
now is the time you really start doing anesthesia by the time of your exam you'll have done maybe a
hundred vivers and each viber may have say one to two challenging situations or issues but what i'm
trying to do with this this process here this session here is to concentrate that experience
so i want to drill the hardest parts of the viva to get you to peak exam fitness so it's really
just high reps focus training it's hit training for this exam is the way i'd like to think about
it now the constant theme that i think of through all of my all of my little topics here is that
there's this kind of concept called the critical issue and something you've probably heard about
you know the critical issue or the main issue or the point of difference and just to just to
really explain what i mean by that um because it is the common thread that we'll go through
every job has many repetitive elements and through your first few years essentially you're learning
what normality is you're learning how to do a standard history you're learning how to do
a standard assessment a standard machine check standard als and bls standard airway assessment
everything is pretty standard standard induction standard pair of progress and that's all new and
you have to repeat that countless times to get your expertise and proficiency but now now you'll
notice that there's some things that are above normal they're really specific or critical for
anesthesia and this exam i'd argue is pointing out those things based on the patient the operation
maybe your surgeon the hospital or your assistant for example a patient might be coming for a lap
collie but they've got a big thyroid mass a thyroid going to um suddenly that really is the
only thing that matters everything else will run pretty smoothly just because it's very standard
maybe the operation is a you know a normal nephrectomy but the tumor's invading near a
vessel so suddenly a normal nephrectomy has this added element of you know blood loss risk chuck
onto that a jehovah's witness patient or someone who might refuse blood and adds another level of
complexity and i'd say that these are the things you need to point towards or direct your attention
to the reviver first and also potentially in real life because the other stuff is normal
and maybe a surgeon is particularly a you know error pronoun maybe they take longer
maybe the hospital is just a day center it doesn't have your uh icu and your ecmo backup
um or maybe that awake fiber optic that you're doing is going to be with the grad nurse and not
the most senior nurse assistant um helping you so in real life these critical issues are really and
you know necessarily what we devote a lot of our attention to and i think that we'll notice
a lot of these things naturally as we go into you know experienced practice but in the vibra this
is what they're looking for it's probably a big thing for me to say that you know to you because
you're you're the other ones who'll be sitting through this exam so in the over the last couple
years i've been an exam observer and i can just guarantee you that they're regularly looking to
hear these critical issues and what's interesting for me is that this is surprisingly never
officially mentioned during your training and i think that is unusual but i can understand why
in my experience as an exam observer it's also interesting because the college
examiners do make expert opinion judgments and this is not necessarily the right thing to do
but it's just the reality and this might be especially difficult if you're not from
an australian culture australian training program so i know in the past over the last few decades
you know victorian anesthesia is very much about you know in epiglottitis you do an inhalational
induction but there's so many cases out there case series out there in many other countries
even other states where people are doing rapid sequence inductions for epiglottitis with no
increased morbidity or mortality similarly with iv induction tamponades i remember one of my
students back in the day he was a chinese aenesis with so much experience with cardiac and
liver anesthesia and he was the very last survivor that he was it there was a tamponade case and he
expressed him during the viva that he would do an iv induction for the tamponade he was the
last survivor and the examiner just happened to ask him well it was interesting that you want to
do an iv induction that's that's not traditionally what we do in australia and he said look i've done
over 100 of these inductions intravenously and not one problem with them that's definitely the
standard that we do in his hospital in china and so while i don't think it's particularly
fair that they might have a certain australian bias i think part of your journey in this exam
is to ask so many questions that you understand what the australian practice is and what normal is
and if you really do believe that you need to do something outside of what you know i guess a
normal realm is then you can make mention of that you can you know appreciate that this is a normal
practice in australia but then go ahead with your plan and i've got to say the examiners are
very reasonable in that regard but they're also just human as well so one of the things is that
examiners are human i mean i think we've all experienced that whether when we're examining
other people or when we're being examined that sometimes they might not hear something
so in amongst everything else that you'll be doing i make particular attention to change my the pace
of my voice the speed the emphasis if i'm about to come to something very important and imagine that
the you know the examiners trying to take something you know written it would be really
pertinent to make sure you have eye contact with them as you're about to make that really
powerful statement they also hear the same thing over and over again so it'd be so important to
you know change the way you phrase things change your speech to make it a bit more interesting and
less full of cliches and the fact is that we're going to be training with each other
throughout all you know the next few months so we will sound quite similar and it's just
important to try and get out of that realm of you know trying to of sounding very similar
this is the marketing guide i had a look at this guide and i definitely don't want you to look at
everything but just to just to understand that the marketing guys can be very subjective like what is
outstanding versus excellent um the failed guys are even less rigorous just to just to know that
they're it's not like there's a table with people marking specific areas you know in this exam
and so the take-home point for me from this is that this exam the interpretation of your
ability can be very subjective and a lot of that is your ability to frame things in the right way
and and just communicate in this way that's just so effective that people perceive your expertise
and again it's just the game we have to play and it's not something i think it's right or
wrong it's just it's just one of those things so the taken point from this there's probably a lot
of subjective subjectivity to it so it's our job to sound professional consultant-like the the way
i look at the survivor is that i think of the vive as having three rough sections anesthesia
knowledge and frameworks then crisis management and then professional document related issues
and just expand that i'm going to try and go from start to finish a process of the viva so
knowledge and content will try to go from the start the summary statement
anaesthetic assessment making decisions a priority statement critical analysis conductions
they'll go through quite a bit of how i frame crisis management and some of the
professional documents that are most likely to be examined so let's begin